Medicament Dispenser

ABSTRACT

A sheet driver for use in a medicament dispenser including a medicament carrier having a plurality of pockets for containing medicament wherein the pockets are spaced along the length of and defined between first and second sheets secured to each other and separable by drivable pulling action, the sheet driver comprises a hub having a hub surface which is adapted to provide an initial effective winding surface which provides uniform indexing of the medicament carrier, and the tensioning of a torsion spring compensates for an increase in the effective winding surface of the hub caused by receipt of the sheet of the medicament carrier about the hub.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application of Ser. No. 11/573,656filed Feb. 13, 2007 now allowed, which was filed under 35 U.S.C. §371 asthe United States National Phase Application of InternationalApplication No. PCT/EP2005/008842 filed Aug. 12, 2005 claiming priorityfrom Great Britain Application No. 0418278.8 filed Aug. 16, 2004.

TECHNICAL FIELD

The present invention relates to a sheet driver component for use in amedicament dispenser for dispensing medicament, in which medicament inpowder or tablet form is carried by an elongate blister strip comprisinga base sheet having pockets defined therein and a lid sheet providedthereto.

BACKGROUND TO THE INVENTION

The use of inhalation devices in the administration of medicaments, forexample in bronchodilation therapy is well known. Such devices generallycomprise a body or housing within which a medicament carrier is located.A known inhalation device has a medicament carrier in the form of anelongate blister strip containing a number of discrete doses ofmedicament in powder or tablet form. The elongate blister stripcomprises a base sheet having pockets defined therein and a lid sheetprovided thereto, wherein the base sheet and lid sheet are peelablyseparable to allow access to the contents of each pocket. Such devicestypically contain a mechanism of accessing these doses comprisingpeeling means for peeling the lid sheet away from the base sheet. Themedicament is thereby made available for delivery to the patient.

Suitable peeling means are positioned to peel apart a base sheet and alid sheet of a pocket at an opening station of the device. The peelingmeans typically includes a (lid or base) sheet driver for pulling aparta lid sheet from a base sheet of a pocket that has been received at theopening station. In one aspect, the sheet driving means comprises afixed-diameter wheel on which the (e.g. lid) sheet is wound, the wheelhaving an effective winding surface, the diameter of which increases asmore (e.g. lid) sheet is wound about said wheel.

A problem encountered with the use of such a fixed-diameter wheel as thesheet driver for driving a sheet of a medicament carrier is that as thesheet winds up around the wheel the effective winding diameter of thewheel increases, and therefore its effective lateral pulling action(i.e. length of pull) also increases. This is problematic because it isdesirable that on actuation, a definable pull action is experienced bythe medicament carrier pocket at the opening station to ensure that agenerally uniform indexing/opening effect is experienced by each pocketof the medicament carrier. In general terms, insufficient pull actionwill result in failure to open up the pocket whilst excess pull will putstress on the mechanical components and increase the force required toactuate the dispenser.

A solution to the above problem has been proposed in Applicant's PCTPatent Application No. WO 03/035509, in which compensating means areprovided to compensate for any increase in the diameter of the effectivewinding surface of the wheel during use of the dispenser and thereby toensure that said medicament carrier is uniformly indexed upon eachactuation of said dispensing mechanism.

The Applicant has now found that a (lid or base) sheet driver having theform of a hub incorporating compensating means in the form of a centralshaft-mounted torsion spring provides particularly effectivecompensation for this increase in diameter.

SUMMARY OF THE INVENTION

According to one aspect of the present invention there is provided asheet driver for use in a medicament dispenser including a medicamentcarrier having a plurality of pockets for containing medicament whereinsaid pockets are spaced along the length of and defined between firstand second sheets secured to each other and separable by drivablepulling action, said sheet driver comprising

(a) a base;

(b) extending from said base, a shaft defining a rotational axis;

(c) at said base, a drive surface for receipt of drive to rotate thebase about said rotational axis;

(d) about said shaft, a torsion spring defining first and second springlegs;

(e) mounting about the shaft and said torsion spring for rotation aboutthe rotational axis, a hub defining a hub surface for receipt of a sheetof said medicament carrier,

wherein a first leg receiver of the base receives said first spring legof the torsion spring and a second leg receiver of said hub receivessaid second spring leg of the torsion spring such that relative rotationof the base and the hub results in tensioning of the torsion spring.

The present invention provides a sheet driver for use in a medicamentdispenser including a medicament carrier having a plurality of pocketsfor containing medicament wherein said pockets are spaced along thelength of and defined between first and second sheets secured to eachother and separable by drivable pulling action.

The sheet driver comprises a base, typically of circular form (e.g.disc-shaped).

Extending (e.g. ascending) from the base, there is provided a shaft. Theshaft may be formed integral with the base or it may be provided as aseparate part to the base for fixing thereto. The shaft defines arotational axis about which the hub is rotatable.

Provided at the base, there is a drive surface for receipt of drive torotate the base about the rotational axis. Suitably, the base hascircular form and the drive surface extends circumferentially about thebase.

Preferably, the drive surface is geared (i.e. defines a gearingsurface), although other types of drive surfaces are envisaged includingthose responsive to frictional and belt drives.

In one aspect, the drive surface is integral with the base. Suitably,the base defines a rim and the drive surface is provided to the rim.

In another aspect, the drive surface is provided to a separate part,which associates with the base.

In a particular aspect, the drive surface is provided to a ring thatfits over and is received by (e.g. engaged by) a rim of the base.Suitably, the drive surface is provided to the outer circumferentialsurface of the ring.

In one embodiment, the inner circumferential surface of the ring is alsoprovided with gearing and the base is provided with a ratchet arm suchthat the base and ring are in ratcheted engagement. Such ratchetedengagement provides that the ring may only be rotated relative to thebase in one rotational sense (e.g. only clockwise or onlyanti-clockwise) with rotation in the other rotational sense beingprevented by the ratchet interaction between inner, geared surface ofthe ring and the ratchet arm of the base.

About said shaft, there is provided a torsion spring. The term ‘spring’herein is used to mean any resilient spring-like means, which may betensioned. The torsion spring defines first and second spring legs thattypically extend away (e.g. protrude) from the ends (e.g. top andbottom) of the spring.

Suitably, the spring is a coiled spring. In one aspect, the spring legsprotrude away from the spring in a direction perpendicular to therotational axis defined by the coils of the spring. In another aspect,the spring legs protrude away from the spring in a direction parallel tothe rotational axis defined by the coils of the spring.

Mounted about the shaft and the torsion spring for rotation about therotational axis, there is provided a hub defining a hub surface forreceipt of a lid or base sheet, preferably lid sheet of said medicamentcarrier. The hub generally fits over the torsion spring and shaft. Thehub itself has a fixed diameter, although its effective winding diameter(i.e. wheel plus thickness of lid or base sheet wound there around) willvary in use as a sheet is accommodated thereby. The hub is typically ofsolid construction and essentially incompressible in nature, at leastabout its diameter.

In aspects, the hub is mounted about the shaft such that it is rotatablein either a clockwise or anti-clockwise sense relative to the base, andhence such that the torsion spring may also be tensed in one or othersense.

Suitably, the hub is provided with means for engaging the end of asheet.

In one aspect, the engaging means comprise surface markings or coatingsprovided to the hub to enhance the frictional contact between the huband the sheet.

In another aspect, loop-engaging means (e.g. a peg, hook, notch or slot)are provided to the hub for engaged receipt of a looped end of a sheet.

The torsion spring of the sheet driver herein, acts to compensate forany increase in the diameter of the effective winding surface of thefixed-diameter hub during winding of sheet thereabout. It is thereforeessential that the sheet driver allow for tensioning of the torsionspring. Accordingly, a first leg receiver of the base receives the firstspring leg of the torsion spring and a second leg receiver of the hubreceives the second spring leg of the torsion spring such that relativerotation of the base and the hub results in tensioning of the torsionspring.

In a preferred aspect, the hub and the base are provided with a lock formutually locking the rotation of the hub relative to the base. Suitably,the lock locates at a defined rotational spacing from a start positionat which the torsion spring is not tensioned, and the or each lockingposition (i.e. when lock is engaged) thereby defines a known tensioningof the torsion spring.

In one aspect, variation of the ‘locking position’ is achievable byvariation of the leg angle defined by the spring leg(s) of the torsionspring.

To apply a known tension to the torsion spring, the hub is thereforerotated (either clockwise or anti-clockwise) from the start position toa particular locking position, at which the lock engages.

In one aspect, the hub is provided with a locking pin receivable by oneor more locking pin receivers of the base. In another aspect, the baseis provided with a locking pin receivable by one or more locking pinreceivers of the hub.

According to another aspect of the present invention there is provided amedicament dispenser for use with medicament carrier having a pluralityof pockets for containing medicament wherein said pockets are spacedalong the length of and defined between first and second sheets securedto each other and separable by drivable pulling action, said dispenserhaving an internal dispensing mechanism for accessing said medicamentcontained within said medicament carrier, said mechanism comprising,

a) an opening station for receiving a pocket of said medicament carrier;

b) peeling means positioned to engage a base sheet and a lid sheet of apocket which has been received in said opening station for peeling apartsuch a base sheet and lid sheet, to open such a pocket, said peelingmeans including a sheet driver as described hereinbefore for pullingapart a lid sheet and a base sheet of a pocket that has been received atsaid opening station;

c) an outlet, positioned to be in communication with an opened pocketthrough which a user can remove medicament from such an opened pocket;and

d) indexer for indexing in communication with said outlet, pockets of amedicament carrier in use with said medicament dispenser, said indexerbeing interconnected with said sheet driver such that movement of onecorrelates with the movement of the other.

According to a further aspect of the present invention there is provideda medicament dispenser for use with plural medicament carriers, eachhaving a plurality of pockets for containing medicament wherein saidpockets are spaced along the length of and defined between first andsecond sheets secured to each other and separable by drivable pullingaction, said dispenser having an internal dispensing mechanism foraccessing said medicament contained within each of said pluralmedicament carriers, said mechanism comprising,

a) an opening station for receiving a pocket of each of said pluralmedicament carriers;

b) peeling means positioned to engage a base sheet and a lid sheet of apocket which has been received in said opening station for peeling apartsuch a base sheet and lid sheet, to open such a pocket, said peelingmeans including a sheet driver as described hereinbefore for pullingapart a lid sheet and a base sheet of a pocket that has been received atsaid opening station;

c) an outlet, positioned to be in communication with an opened pocketthrough which a user can remove medicament from such an opened pocket;and

d) indexer for indexing in communication with said outlet, pockets ofeach of said plural medicament carriers in use with said medicamentdispenser, said indexer being interconnected with said sheet driver suchthat movement of one correlates with the movement of the other.

The sheet driver comprises a fixed-diameter hub on which said base orlid sheet, preferably lid sheet is wound, said hub having an effectivewinding surface, the diameter of which increases as more sheet is woundabout said hub.

The torsion spring acts to compensate for any increase in the diameterof the effective winding surface of the fixed-diameter hub during use ofthe dispenser and to thereby ensure that said medicament carrier isuniformly indexed upon each actuation of said dispensing mechanism. Thetorsion spring also acts to ensure that a minimum peeling force betweenthe base sheet and lid sheet is present during actuation of thedispensing mechanism.

In particular, the torsion spring act such as to vary the drive functioncharacteristics of the hub to compensate for any increase in thediameter of the effective winding surface of the hub during use of thedispenser. Thereby, the medicament carrier is uniformly indexed (i.e.typically indexed by the same length of strip) as a result of eachactuation of the dispensing mechanism, and the pocket opening actionexperienced by the strip is also uniform.

The medicament dispenser herein is suitable for use with a medicamentcarrier having a plurality of pockets for containing medicament whereinsaid pockets are essentially uniformly spaced along the length of anddefined between two peelably separable sheets secured to each other. Themedicament carrier is generally in the form of an elongate, peelableblister strip.

It will have been appreciated that the torsion spring functions such asto compensate for an increase in the diameter of the effective windingsurface of the wheel during use of the dispenser. It will be appreciatedthat the initial effective winding surface and associated initial drive‘speed’ of the hub is principally a function of the (fixed) initialdiameter of the hub. Variations are envisaged herein where that initialeffective winding surface is selected to define particularly selectedinitial drive characteristics of the hub.

In one variation sometimes called ‘one way take up’ mode, the initialeffective winding surface is selected such as to initially provide ideal(i.e. uniform) indexing of the medicament carrier. As lid sheet winds uparound the hub the effective winding surface increases and the torsionspring acts such as to compensate for that increase.

In another variation sometimes called ‘two way take up’ mode, theinitial effective winding surface is selected such as to initiallyprovide non-ideal (i.e. non-uniform) indexing of the medicament carrierbecause the diameter of the hub is insufficiently great. As lid sheetwinds up around the hub the effective winding surface increases to anideal diameter and then on further winding up continues to increase to anon-ideal (i.e. too great diameter). In this embodiment it will beappreciated that the degree and nature of compensation provided by thetorsion spring will vary over the winding up function. The torsionspring initially acts such as to compensate for the insufficient wheeldiameter. That compensation then decreases to zero at the point wherethe diameter of the effective winding surface is ideal. The compensationthen progressively acts such as to compensate for a too great effectivewinding surface. This approach has the advantage of overall reducing the(average) compensating torsion force experienced by the medicamentcarrier from a defined zero (i.e. the ideal) and enables the use of lesspowerful tensioning means (e.g. a smaller torsion spring). In apreferred aspect of this variation, the ideal effective winding surfacediameter is selected to correspond approximately to the point at whichhalf of the lid sheet is wound up on the hub, in which case the average(i.e. mean) compensating action experienced is by the carrier over afull usage cycle is close to zero.

Suitably, said indexer comprises a rotatable index wheel having recessestherein, said index wheel being engageable with a medicament carrier inuse with said medicament dispenser such that said recesses each receivea respective pocket of the base sheet of a medicament carrier in usewith said medicament dispenser.

Alternatively, said index means may comprise an indexing ratchet whichis moveable between a locked position whereby said ratchet engages apocket on said medicament carrier and prevents further peeling thereof,and a release position allowing free movement of said medicamentcarrier, and actuation of said medicament dispenser actuates said sheetdriver and releases said index ratchet from said medicament carrier toallow peeling thereof.

Suitably, the medicament dispenser further comprises an indexing leverfor actuating said dispenser wherein said indexing lever isinterconnected with said indexer and/or said sheet driver.

In one aspect, the sheet driver and/or the indexer are operated by anelectronic drive system. The electronic drive system may also be used inconjunction with a mechanical drive system.

The electronic drive typically comprises a motor, preferably anelectrically powered motor. The motor may provide linear or rotarydrive, but in general, rotary motors are most suitable. The motor mayfor example, comprise a DC electric motor, a piezoelectric (PZ) motor,an ultrasonic motor, a solenoid motor or a linear motor. Preferably, theelectronic drive system comprises a DC motor, a PZ motor or anultrasonic motor.

Suitably, the peeling means additionally comprises a guide for guidingthe lid sheet and base sheet along separate paths at the openingstation. The lid sheet is passed around the guide portion onto the sheetdriver.

Suitably, the guide comprises a roller mechanism. The lid sheet is fedover the rollers onto the sheet driver.

Suitably, the internal mechanism additionally comprises a first chamberin which the strip is initially housed and from which it is dispensedand a second chamber to receive the used portion of the base sheet afterit has been indexed and separated from the lid sheet.

Suitably, a wall separates the first chamber and second chamber. In oneaspect, the wall is movable to adjust the size of said first and secondchambers. In another aspect, the wall is flexibly movable to adjust thesize of the first and second chambers. In a further aspect, the secondchamber is expandable to create space for the growing coil of the usedportion of the base sheet.

Suitably, the internal mechanism further comprises a third chamber toreceive the used portion of the lid sheet and a fourth chamber thathouses the indexer. The fourth chamber may communicate via a slit, whichin turn extends upwardly within a mouthpiece or exit channel andcommunicates with air inlets.

Suitably, the internal mechanism additionally comprises a crushing wheelto crush the medicament pockets after the medicament has been removedfrom them. The crushing wheel therefore reduces the space, which theused portion of the base sheet takes up.

Typically, the internal mechanism for accessing said medicamentcontained within said medicament carrier is housed within a cassette.

In one aspect, the invention provides a medicament dispenser fordispensing medicament comprising: a body; a holder, shaped to fit withinsaid body and movable relative to said body; and receivable by saidholder, said cassette containing said medicament carrier.

Suitably, movement of the holder relative to the body results inmovement of the cassette between a first position and a second positionsuch that the cassette is reversibly removable from the holder when thecassette is in the second position.

Suitably, the first position comprises a dispensing position. Preferablythe second position comprises a non-dispensing position. The cassette istherefore only removable from the holder when the cassette is in thenon-dispensing position.

Suitably, the holder and body include attaching means to attach theholder to the body. Preferably said attaching means comprise a snap fitmechanism.

Suitably, said snap fit mechanism comprises a pin and hole system.

Suitably, the holder is pivotally movable relative to the body.Alternatively, the holder is rotationally movable relative to the body.

Suitably, the holder additionally comprises a stop to limit movement ofthe holder relative to the body. The stop abuts against the edge of thebody at two points when it is rotated. At these points the holder may bedesigned to click into place. Therefore when the stop abuts one bodyedge then it is clicked into the dispensing position and when the stopabuts the other body edge then it is clicked into the non-dispensingposition.

Suitably, the holder is slidably movable relative to the body.

Suitably, the holder additionally comprises a catch to retain thecassette. The catch may for example comprise a sprung pin that fits intoa hole or an integral catch that deforms when pressed allowing removalof the cassette.

Suitably, the catch is child resistant. Child resistance may be realisedby having a system that forces the user to perform two actions at onceto remove the cassette. Other features of the catch may include shock orimpact resistance, the ability to lock the catch and orientationfeatures to ensure that the cassette can only be inserted one way. Thecatch should also be easy to manufacture and assemble, be robust, becomposed of a minimal number of components and intrude minimally intothe space into which the cassette is inserted.

Suitably, the holder includes guide means to guide the cassette into theholder. Preferably said guide means comprise guide rails. Alternativelythe guide means comprise grooves, indentations or other shaping orsurface details to define a ‘lock and key’ relationship between theholder and the cassette. Colour guides, arrows and any other surfacemarkings may also be employed.

Suitably, the cassette additionally comprises an indexing lever. Theindexing lever has a finger tab located outside the body of thecassette. The rest of the indexing lever is located within the cassette.The indexing lever may have teeth at its tail end and/or teeth along itsmid portion.

Suitably, the cassette additionally comprises a mouthpiece.

In one aspect, said mouthpiece is extendible. The mouthpiece extends asthe cassette and holder are moved from the non-dispensing position tothe dispensing position.

Alternatively, the mouthpiece is retractable. The mouthpiece retracts asthe cassette and holder are moved from the dispensing position to thenon-dispensing position.

The medicament dispenser may also be designed for nasal inhalation of apowdered medicament and may therefore incorporate a nosepiece as analternative to a mouthpiece. If the medicament is in solid form, thedispenser may incorporate an exit channel for tablet release.

Suitably, the body covers the mouthpiece and indexing lever when thecassette is in the non-dispensing position. This avoids the need for aseparate cover and protects the mouthpiece from the ingress of dirt andcontaminants during storage.

Suitably, the cassette additionally comprises a raised portion to fitagainst the holder. The raised portion is located at the opposite end ofthe cassette to the mouthpiece/nosepiece/exit and indexing lever andprevents the incorrect insertion of the cassette into the holder sinceit is too wide to fit into the holder. The raised portion is shaped suchthat it fits against a cut away part of the holder. Preferably saidraised portion includes a section that is raised to define a gripportion.

Suitably, at least a portion of the holder and body are shaped for easeof grip by the user. Suitably, operation of the device may be performedwith one hand.

Suitably, the body additionally comprises at least one brush or wiperblade located along its top or bottom side that brush against the topand bottom surfaces of the inside of the cassette. The brush or wiperblade acts to close off the chamber for enclosing the medicament carrierfrom the rest of the body of the cassette and to prevent any loosepowder from entering the rest of the cassette. Loose powder may enterthe chamber from the used portion of the blister strip if the patientindexes the strip by pressing the lever when they do not intend to takea dose or when they fail to inhale all the powder.

Suitably, the medicament dispenser comprises an actuation or dosecounter for counting the number of actuations of the indexing lever orreleases of dose from the cassette. The dose counter may count thenumber of doses left to be taken or the number of doses taken. Suitably,said dose counter is electronic. Alternatively, said dose counter ismechanical.

Alternatively, the blister strip has printed numbers on it correspondingto the doses in the pockets. Preferably said printed numbers are visiblethrough a window in the cassette. The device may be assembled asfollows. The holder is snap fitted into the body. The cassette isassembled separately. The body of the cassette is formed, preferably intwo sections with any necessary spindles or integral components formedinto the base. Individual components such as indexing wheels, lidwinding mechanisms, guide portions etc are then assembled into the base.Finally the medicament containing blister strip (or other suitablemedicament carrier) may be inserted into the cassette. This may be woundinto the device before the lid is attached to the cassette and thecassette sealed. Alternatively, the cassette may be formed completelyapart from a hole left in its side for insertion of the blister strip ormedicament carrier. The hole may then be sealed to complete thecassette. This second method of inserting the medicament carrier intothe device has the advantage that it is much simpler.

Suitably, the medicament dispenser additionally comprises an electronicdata management system. The electronic data management system hasinput/output capability and comprises a memory for storage of data; amicroprocessor for performing operations on said data; and a transmitterfor transmitting a signal relating to the data or the outcome of anoperation on the data.

Suitably, the medicament dispenser additionally comprises a data inputsystem for user input of data to the electronic data management system.Preferably, the data input system comprises a man machine interface(MMI) preferably selected from a keypad, voice recognition interface,graphical user interface (GUI) or biometrics interface.

Suitably, the system additionally comprises a visual display unit fordisplay of data from the electronic data management system to the user.The display may for example, comprise a screen such as an LED or LCDscreen. More preferably the visual display unit is associable with thebody of the medicament dispenser.

Suitably, the medicament dispenser additionally comprises a datalink forlinking to a local data store to enable communication of data betweenthe local data store and the electronic data management system. Thedatastore may also comprise data management, data analysis and datacommunication capability.

The medicament dispenser may additionally comprise a safety mechanism toprevent unintended multiple actuations of the dispensing mechanism. Thepatient is thereby protected from inadvertently receiving multiple dosesof medicament in a situation where they take a number of short rapidbreaths. More preferably, the safety mechanism imposes a time delaybetween successive actuations of the release means. The time delay istypically of the order of from three to thirty seconds.

Suitably, the medicament dispenser additionally comprises a releasedetector for detecting release of medicament from the cassette, whereinsaid release detector transmits release data to the electronic datamanagement system.

Suitably, the medicament dispenser additionally comprises a shakedetector for detecting shaking of the medicament container (e.g. priorto actuation of the dispensing mechanism), wherein said shake detectortransmits shake data to the electronic data management system.

Suitably, any actuation detector, release detector, or shake detectorcomprises a sensor for detecting any suitable parameter such asmovement. Any suitable sensors are envisaged including the use ofoptical sensors. The release detector may sense any parameter affectedby release of the medicament such as pressure, temperature, sound,moisture, carbon dioxide concentration and oxygen concentration.

The medicament dispenser herein suitably contains a medicament carrierhaving a plurality of pockets for containing medicament wherein saidpockets are essentially uniformly spaced along the length of and definedbetween two peelably separable sheets secured to each other. Themedicament carrier is generally in the form of an elongate, peelableblister strip.

Suitably, the peelable blister strip comprises a base sheet in whichblisters are formed to define pockets therein for containing distinctmedicament dose portions and a lid sheet which is hermetically sealed tothe base sheet except in the region of the blisters in such a mannerthat the lid sheet and the base sheet can be peeled apart. The base andlid sheets are typically sealed to one another over their whole widthexcept for the forward end portions where they are typically not sealedto one another at all. Thus, separate base and lid sheet forward endportions are presented at the end of the strip. The respective base andlid sheets are peelably separable from each other to (e.g. separately)release the contents of each pocket.

In one aspect, the leading end of either the base or lid sheet or islooped to enable better receipt by the hub of the sheet driver herein.

In one aspect, the medicament carrier comprises a peelable blister stripin laminate form. Suitably, the laminate comprises material selectedfrom the group consisting of metal foil, organic polymeric material andpaper. Suitable metal foils include aluminium or tin foil having athickness of from 5 to 100 μm, preferably from 10 to 50 μm, such as 20to 30 μm. Suitable organic polymeric materials include polyethylene,polypropylene, polyvinyl chloride and polyethylene terephthalate.

Suitably, the lid sheet comprises at least the following successivelayers: (a) paper; adhesively bonded to (b) polyester; adhesively bondedto (c) aluminium foil; that is coated with a heat seal lacquer forbonding to the base sheet. The thickness of each layer may be selectedaccording to the desired properties but is typically of the order offrom 5 to 200 micron, particularly from 10 to 50 micron.

Suitably, the base sheet comprises at least the following successivelayers: (a) oriented polyamide (OPA); adhesively bonded to (b) aluminiumfoil; adhesively bonded to (c) a third layer comprising a polymericmaterial (e.g. polyvinyl chloride).

Various known techniques can be employed to join the lid and base sheetand hence to seal the blisters of the peelable blister strip. Suchmethods include adhesive bonding, hot metal bonding, hot metal welding,radio frequency welding, laser welding, ultrasonic welding and hot barsealing. The lid sheet and base sheet of the peelable blister strip areparticularly sealable by ‘cold form’ sealing methods, which areconducted at lower temperatures than conventional heat sealing methods.Such ‘cold form’ sealing methods are of particular utility where themedicament or medicament formulation for containment within the blisteris heat sensitive (e.g. degrades or denatures on heating). Suitable‘cold form’ sealing methods are conducted at a temperature in the rangeof 150-250° C., more preferably, 210-240° C.

The medicament may comprise a capsule, pellet or tablet. Alternatively,the medicament may be in powdered form. Preferably, when in powderedform the medicament comprises a drug. Preferably the drug is selectedfrom the group consisting of albuterol, salmeterol, fluticasonepropionate and beclomethasone dipropionate and salts or solvates thereofand any combination thereof. Preferably said combination comprisessalmeterol xinafoate and fluticasone propionate.

Suitably, the powdered medicament additionally comprises an excipient.Suitably, said excipient is a sugar.

In another aspect, the invention provides the use of a medicamentdispenser as described hereinbefore.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will now be described with reference to the accompanyingdrawings in which:

FIG. 1 shows a perspective view of a medicament carrier for with amedicament dispenser in accord with the present invention;

FIGS. 2 a to 2 k show perspective views of details of the assembly of asheet driver herein;

FIGS. 3 a to 3 f show perspective views of the incorporation of thesheet driver assembled as in FIGS. 2 a to 2 k into a medicamentdispenser herein

FIG. 4 a shows a perspective view of a medicament dispenser having afirst elongate strip form medicament carrier received thereby, and theinsertion of second elongate strip form medicament carrier there into;

FIG. 4 b shows the medicament dispenser of FIG. 4 b with the secondelongate strip form medicament carrier received thereby;

FIGS. 5 a to 5 h show perspective views of details of the assembly of asecond sheet driver herein; and

FIGS. 6 a to 6 d shows perspective views of the attachment of the end ofa medicament carrier to the second sheet driver of FIGS. 5 a to 5 h.

DETAILED DESCRIPTION OF THE DRAWINGS

Referring now to the Figures, FIG. 1 shows a medicament carrier 100 foruse in accord with the medicament dispenser of the present invention.The medicament carrier comprises a flexible strip 102 defining aplurality of pockets 104, 106, 108 each of which contains a dose ofmedicament that can be inhaled, in the form of powder.

The strip comprises a base sheet 110 in which blisters are formed todefine the pockets 104, 106, 108 and a lid sheet 112 which ishermetically sealed to the base sheet except in the region of theblisters in such a manner that the lid sheet 112 and the base sheet 110can be peeled apart. The sheets 110, 112 are sealed to one another overtheir whole width except for the leading end portions 114, 116 wherethey are preferably not sealed to one another at all. The leading endportion 116 of the lid sheet 112 is looped for engagement with a hub ofa sheet driver, as will be described in more detail hereinafter. The lid112 and base 112 sheets are each preferably formed of aplastics/aluminium laminate and are preferably adhered to one another byheat sealing.

The strip 102 is shown as having uniformly-spaced elongate pockets 104,106, and 108 that run transversely with respect to the length of thestrip 102. This is convenient in that it enables a large number ofpockets 104, 106, 108 to be provided in a given strip 102 length. Thestrip 102 may, for example, be provided with sixty or one hundredpockets but it will be understood that the strip 102 may have anysuitable number of pockets.

FIGS. 2 a to 2 k show details of the assembly of a first sheet driverherein. In respect of each of the Figures, only the most relevant partsfor that Figure are labelled.

Referring initially to FIGS. 2 a and 2 b, circular form base 220 may beseen to have geared drive surface 225 provided to circumferential rim222 and integral, upwardly extending shaft 230. Torsion spring 240having lower 242 and upper 244 spring ends is lowered onto shaft 230such that lower spring end 242 engages in spring leg retainer slot 224of base 220. The shaft 230 also has a protruding lip 234, the functionof which will become clearer from the later description.

Referring now to FIGS. 2 c to 2 e, hub 250 is lowered onto shaft 230such that it sits over torsion spring 240. It may be seen that upperspring leg 244 of torsion spring 240 is received by spring leg retainerslot 252 provided to the inner part of the hub 250. Upper end 232 of theshaft 230 protrudes through central aperture 254 of the lid end 256 ofthe hub 250. The hub 250 may also be seen to be provided with anupwardly standing hook 258 part arranged for receipt of the looped endof a sheet, as will be described in more detail hereinafter.

Referring now to FIGS. 2 f to 2 h, hub 250 is now rotated in a clockwisedirection (in alternative embodiments, anti-clockwise rotation isenvisaged) by a defined rotation (in this case about 135°) relative tothe base 220. It will be appreciated that because the spring legs oftorsion spring (not visible in FIGS. 2 f to 2 h) attach respectively tothe base 220 and hub 250, such rotation results in tensing of thetorsion spring. The extent of defined rotation is selected such as toalign a stepped wall 255 of the underside of the hub 250 with the edgeof the wall 223 that forms part of retainer slot 224 for lower springleg 242.

As shown at FIGS. 2 i to 2 k, the hub 250 is then pressed home (i.e.downwards towards the base 220) such that the central aperture 254thereof snap-fits over the lip 234 of shaft 230 to retain the hub 250 tothe base 220. The torsion spring (not visible in FIGS. 2 i to 2 k) doesnot unwind from its tensed state as a result of the interaction of thestepped wall 255 of the underside of the hub 250 with the edge of thewall 223 that forms part of retainer slot 224 for lower spring leg 242(all visible in FIG. 2 i only).

The sheet driver assembly is now ready for use in a suitable medicamentdispenser. FIGS. 3 a to 3 f show perspective views of the assembly ofthe drive unit 260 of a medicament dispenser herein. The drive unit 260is arranged for use in a medicament dispenser for use with pluralmedicament carriers, each of the type shown at FIG. 1 and having aplurality of pockets 104, 106, 108 for containing medicament whereinsaid pockets 104, 106, 108 are spaced along the length of and definedbetween a base sheet 110 and lid sheet 112, the sheets 110, 112 securedto each other and peelably separable by drivable pulling action

Referring to FIG. 3 a, drive unit 260 is arranged for receipt of firstand second sheet drivers 218 a, 218 b such that the hubs 250 a, 250 bthereof extend through apertures 262 a, 262 b provided to the base 261of the drive unit. The bases 220 a, 220 b of the drivers 218 a, 218 bprotrude upwards from the apertures 262 a, 262 b such that therespective hubs 250 a, 250 b are rotatably drivable by rotary drivemotion of the geared drive surfaces 225 a, 225 b of the respective bases220 a, 220 b.

Referring to FIG. 3 b, the geared drive surfaces 225 a, 225 b of therespective bases 220 a, 220 b of may be seen to interact with complexgear train 265 provided to the base 261 of the drive unit 260. The geartrain 265, and hence rotation of each respective base 220 a, 220 b isultimately drivable by primary index gear 270, which interacts withratchet unit 272, the purpose of which is to prevent reverse rotation ofthe primary index gear 270.

Referring to FIG. 3 c, the primary index gear 270 may be seen in turn,to be drivable by index lever 274, which pivots about pivot point 275.Thus, actuation of the sheet drivers 218 a, 218 b is by pivotal movementof the index 274 to rotate the primary index gear 270, which accordinglyresults in transfer of drive through gear train 265 to the geared drivesurfaces 225 a, 225 b of the bases 220 a, 220 b of both of the sheetdrivers 218 a, 218 b.

Referring now to FIGS. 3 d to 3 f, first 282 and second 284 shell partsof dispenser housing 280 are applied to the drive unit 260. It may beseen that mouthpiece 281 is defined by shell parts 282, 284 in tandem.In FIGS. 3 e and 3 f (only) movable cover 286 is also seen to have beenfitted over peg 273 of index lever 274 such that movement of the cover286 will result in movement of the index lever 274, and thus in turnactuate the mechanism for driving the sheet drivers 218 a, 218 b.Overall, in use, patient movement of the movable cover 286 provides themeans for advancing the sheet drivers 218 a, 218 b, and hence theindividual medicament doses held within pockets of the medicamentcarrier.

The interaction of the medicament carriers with the drive unit of thedispenser of FIGS. 3 e and 3 f may be better understood by reference toFIGS. 4 a and 4 b. FIG. 4 a shows the medicament dispenser of FIG. 3 e(a) having the top shell 282 and movable cover 286 removed (for bettervisibility of the inner workings); and (b) having a first elongate stripform medicament carrier 302 a received thereby, and illustrating theinsertion of second elongate strip form medicament carrier 302 b thereinto. FIG. 4 b shows the medicament dispenser of FIG. 4 b with thesecond elongate strip form medicament carrier 302 b received thereby.

In more detail, FIGS. 4 a and 4 b illustrate a base unit 360 of amedicament dispenser herein. First and second medicament-containingblister strips 302 a, 302 b are arranged to be accommodated withinrespective left and right chambers 390 a, 390 b of the base unit 360. Itwill be appreciated that each blister strip 302 a, 302 b has the formshown in FIG. 1. Within the dispenser, each blister strip 302 a, 302 bengages in respective multi-pocket index wheel 392 a, 392 b, andsuccessive pockets are thereby guided towards a central opening station393. The rotation of the index wheels 392 a, 392 b is optionally coupledtogether (e.g. via a suitable gear train such as shown in FIG. 3 b). Atthe opening station 393, the lid foil 312 a, 312 b and base foil 314 a,314 b parts of each strip 302 a, 302 b are peelably separable about beak(not clearly visible). The resulting empty base foil 314 a, 314 b coilsup in respective base take-up chambers 315 a, 315 b. A base foil anchor317 a, 317 b anchors the end of each respective base foil 314 a, 314 bin its chamber 315 a, 315 b.

The looped end 316 a, 316 b of each lid foil 312 a, 312 b of eachcarrier 302 a, 302 b is received by upwardly standing hook 358 a, 358 bpart of its respective torsion hub 350 a, 350 b drive. The innerstructure of each torsion hub drive 350 a, 350 b is as described byreference to FIGS. 2 a to 2 k, or in an alternative embodiment is thatdescribed by reference to FIGS. 5 a to 5 h.

The function of each torsion hub drive 350 a, 350 b is to ensure aroughly constant driving tension is provided to each strip 302 a, 302 bover the course of each entire strip length. In particular, each torsionhub 350 a, 350 b acts to compensate for the variation in drive tensionassociated with the increase in the effective winding diameter of eachhub 350 a, 350 b as used lid foils 312 a, 312 b gradually becomeswrapped there around. Thus, uniform indexing of each strip 302 a, 302 bmay be maintained over the entire strip length.

In use, the dispenser is primed (typically by means of an actuatinglever, for example in the form of a movable cover 286 as shown in FIGS.3 e, 3 f) to drivably actuate each torsion hub drive 350 a, 350 bassociated with each carrier 302 a, 302 b, thereby causing the leadingpocket thereof to be peeled open. Each torsion hub 350 a, 350 b acts toprovide any necessary drive compensation, as described above. To accessthe contents of the opened pockets the patient then breathes in throughthe outlet 381 (which is typically shaped as a mouthpiece or nasalnozzle). This results in negative pressure being transmitted throughmanifold 383 to the opened leading pocket of each strip 302 a, 302 b atthe opening station 393. This in turn, results in the medicament powdercontained within each of the opened pockets being drawn out through thecommon manifold 383 to the outlet 381 and hence to the patient as aninhaled combination medicament dose. It be appreciated that, mixing ofeach separately delivered component of the combined medicament producthappens as the powder is transported from each opened pocket to theoutlet 381.

FIGS. 5 a to 5 h show perspective views of details of the assembly of asecond sheet driver herein.

Referring initially to FIGS. 5 a and 5 b, circular form base 320 isprovided with ratchet arm 321. Ring 323 having a first geared drivesurface 325 provided to its outer circumference and a second gearedsurface 327 provided to its inner circumference is pressed onto the base320. When pressed home, it may be seen that ratchet arm 321 of the base320 is in ratcheted engagement with the second (i.e. inner) gearedsurface 327 of the ring such that the ring 323 may only be rotated inone direction relative to the base 320. Shaft 330 extends away from thebase 320.

Referring now to FIGS. 5 c and 5 d, torsion spring 340 having lower 342and upper 344 spring ends is lowered onto shaft 330 such that lowerspring end 342 engages in spring leg retainer slot 324 of base 320. Theshaft 330 also has a protruding notch 334, the function of which willbecome clearer from the later description.

Referring now to FIGS. 5 e and 5 f, hub 350 is lowered onto shaft 330such that it sits over torsion spring 340. Upper spring leg of torsionspring 340 is received by spring leg retainer slot (not visible)provided to the inner part of the hub 350. Upper end 332 of the shaft330 protrudes through central aperture 354 of the lid end 356 of the hub350. The hub 350 may also be seen to be provided with a hook 358 partarranged for receipt of the looped end of a sheet, as will be describedin more detail hereinafter.

Referring now to FIGS. 5 g to 5 h, hub 350 is now rotated in ananti-clockwise direction (in alternative embodiments, clockwise rotationis envisaged) by a defined rotation (in this case about 90°) relative tothe base 320. It will be appreciated that because the spring legs oftorsion spring (not visible in FIGS. 5 g to 5 h) attach respectively tothe base 320 and hub 350, such rotation results in tensing of thetorsion spring. The extent of defined rotation is selected such as toalign a stepped wall (not visible) of the underside of the hub 350 withthe edge of the wall (not visible) that forms part of retainer slot forlower spring leg 342.

The torsion spring (not visible in FIGS. 5 g to and 5 h) does not unwindfrom its tensed state as a result of the ratcheted interaction betweenthe ratchet arm 321 of the base 320 and the inner geared surface 327 ofthe ring 323.

One advantage of the ‘ratcheted hub’ form of sheet driver as shown inFIGS. 5 a to 5 h is that it allows for flattening out of any variationof spring tolerances. Such variation of spring tolerance often occurswhen springs are manufactured in bulk.

The second sheet driver assembly is now ready for use in a suitablemedicament dispenser.

FIGS. 6 a to 6 d show the attachment of the end of a medicament carrierto the hub 350 of the second sheet driver of FIGS. 5 a to 5 h.

FIG. 6 a shows the second sheet driver 318 loaded into a drive unit 360of a suitable medicament dispenser with the hook 358 part of the hub 350facing outwards. In FIG. 6 b, a looped end 316 of the lid sheet 312 of amedicament carrier (of the type shown in FIG. 1) is looped over the hook358 of the hub 350. In FIGS. 6 c and 6 d, the sheet driver 318 isrotated thereby causing the lid sheet 312 to wrap around the hub 350until all slack is taken up.

The medicament dispenser herein is suitable for dispensing medicament,particularly for the treatment of respiratory disorders such as asthmaand chronic obstructive pulmonary disease (COPD), bronchitis and chestinfections. Appropriate medicaments may thus be selected from, forexample, analgesics, e.g., codeine, dihydromorphine, ergotamine,fentanyl or morphine; anginal preparations, e.g., diltiazem;antiallergics, e.g., cromoglycate (e.g. as the sodium salt), ketotifenor nedocromil (e.g. as the sodium salt); antiinfectives e.g.,cephalosporins, penicillins, streptomycin, sulphonamides, tetracyclinesand pentamidine; antihistamines, e.g., methapyrilene;anti-inflammatories, e.g., beclomethasone (e.g. as the dipropionateester), fluticasone (e.g. as the propionate ester), flunisolide,budesonide, rofleponide, mometasone e.g. as the furoate ester),ciclesonide, triamcinolone (e.g. as the acetonide) or6α,9α-difluoro-11β-hydroxy-16α-methyl-3-oxo-17α-propionyloxy-androsta-1,4-diene-17β-carbothioicacid S-(2-oxo-tetrahydro-furan-3-yl)ester; antitussives, e.g.,noscapine; bronchodilators, e.g., albuterol (e.g. as free base orsulphate), salmeterol (e.g. as xinafoate), ephedrine, adrenaline,fenoterol (e.g. as hydrobromide), formoterol (e.g. as fumarate),isoprenaline, metaproterenol, phenylephrine, phenylpropanolamine,pirbuterol (e.g. as acetate), reproterol (e.g. as hydrochloride),rimiterol, terbutaline (e.g. as sulphate), isoetharine, tulobuterol or4-hydroxy-7-[2-[[2-[[3-(2-phenylethoxy)propyl]sulfonyl]ethyl]amino]ethyl-2(3H)-benzothiazolone;adenosine 2a agonists, e.g.2R,3R,4S,5R)-2-[6-Amino-2-(1S-hydroxymethyl-2-phenyl-ethylamino)-purin-9-yl]-5-(2-ethyl-2H-tetrazol-5-yl)-tetrahydro-furan-3,4-diol(e.g. as maleate); α₄ integrin inhibitors e.g.(2S)-3-[4-({[4-(aminocarbonyl)-1-piperidinyl]carbonyl}oxy)phenyl]-2-R(2S)-4-methyl-2-{[2-(2-methylphenoxy)acetyl]amino}pentanoyl)amino]propanoicacid (e.g. as free acid or potassium salt), diuretics, e.g., amiloride;anticholinergics, e.g., ipratropium (e.g. as bromide), tiotropium,atropine or oxitropium; hormones, e.g., cortisone, hydrocortisone orprednisolone; xanthines, e.g., aminophylline, choline theophyllinate,lysine theophyllinate or theophylline; therapeutic proteins andpeptides, e.g., insulin or glucagon; vaccines, diagnostics, and genetherapies. It will be clear to a person skilled in the art that, whereappropriate, the medicaments may be used in the form of salts, (e.g., asalkali metal or amine salts or as acid addition salts) or as esters(e.g., lower alkyl esters) or as solvates (e.g., hydrates) to optimisethe activity and/or stability of the medicament.

Preferred medicaments are selected from albuterol, salmeterol,fluticasone propionate and beclomethasone dipropionate and salts orsolvates thereof, e.g., the sulphate of albuterol and the xinafoate ofsalmeterol.

Medicaments can also be delivered in combinations. Preferredformulations containing combinations of active ingredients containsalbutamol (e.g., as the free base or the sulphate salt) or salmeterol(e.g., as the xinafoate salt) or formoterol (eg as the fumarate salt) incombination with an anti-inflammatory steroid such as a beclomethasoneester (e.g., the dipropionate) or a fluticasone ester (e.g., thepropionate) or budesonide. A particularly preferred combination is acombination of fluticasone propionate and salmeterol, or a salt thereof(particularly the xinafoate salt). A further combination of particularinterest is budesonide and formoterol (e.g. as the fumarate salt).

Generally, powdered medicament particles suitable for delivery to thebronchial or alveolar region of the lung have an aerodynamic diameter ofless than 10 micrometers, preferably less than 6 micrometers. Othersized particles may be used if delivery to other portions of therespiratory tract is desired, such as the nasal cavity, mouth or throat.The medicament may be delivered as pure drug, but more appropriately, itis preferred that medicaments are delivered together with excipients(carriers) which are suitable for inhalation. Suitable excipientsinclude organic excipients such as polysaccharides (i.e. starch,cellulose and the like), lactose, glucose, mannitol, amino acids, andmaltodextrins, and inorganic excipients such as calcium carbonate orsodium chloride. Lactose is a preferred excipient.

Particles of the powdered medicament and/or excipient may be produced byconventional techniques, for example by micronisation, milling orsieving. Additionally, medicament and/or excipient powders may beengineered with particular densities, size ranges, or characteristics.Particles may comprise active agents, surfactants, wall formingmaterials, or other components considered desirable by those of ordinaryskill.

The excipient may be included with the medicament via well-knownmethods, such as by admixing, co-precipitating and the like. Blends ofexcipients and drugs are typically formulated to allow the precisemetering and dispersion of the blend into doses. A standard blend, forexample, contains 13000 micrograms lactose mixed with 50 microgramsdrug, yielding an excipient to drug ratio of 260:1. Dosage blends withexcipient to drug ratios of from 1000:1 to 1:1 may be used. At very lowratios of excipient to drug, however, the drug dose reproducibility maybecome more variable.

The present application claims priority from UK patent application No.04 182 78.8 filed on 16 Aug. 2004, the entire content of which is herebyincorporated herein by reference.

It will be understood that the present disclosure is for the purpose ofillustration only and the invention extends to modifications, variationsand improvements thereto. The application of which this description andclaims form part may be used as a basis for priority in respect of anysubsequent application. The claims of such subsequent application may bedirected to any feature or combination of features described therein.They may take the form of product, method or use claims and may include,by way of example and without limitation, one or more of the followingclaims:

1. A sheet driver for use in a medicament dispenser including amedicament carrier having a plurality of pockets for containingmedicament wherein said pockets are spaced along the length of anddefined between first and second sheets secured to each other andseparable by drivable pulling action, said sheet driver comprising (a) abase; (b) extending from said base, a shaft defining a rotational axis;(c) at said base, a drive surface for receipt of drive to rotate thebase about said rotational axis; (d) about said shaft, a torsion springdefining first and second spring legs; (e) mounting about the shaft andsaid torsion spring for rotation about the rotational axis, a hubdefining a hub surface for receipt of a sheet of said medicamentcarrier, wherein a first leg receiver of the base receives said firstspring leg of the torsion spring and a second leg receiver of said hubreceives said second spring leg of the torsion spring such that relativerotation of the base and the hub results in tensioning of the torsionspring, wherein the hub surface is adapted to provide an initialeffective winding surface which provides uniform indexing of saidmedicament carrier, and the tensioning of the torsion spring compensatesfor an increase in the effective winding surface of the hub caused byreceipt of said sheet of said medicament carrier about the hub.
 2. Asheet driver according to claim 1, wherein the base is of essentiallycircular form.
 3. A sheet driver according to claim 1, wherein the shaftis integral with the base.
 4. A sheet driver according to claim 1,wherein the drive surface defines a gearing surface.
 5. A sheet driveraccording to claim 1, wherein the drive surface extendscircumferentially about the base.
 6. A sheet driver according to claim1, wherein the drive surface is integral with the base.
 7. A sheetdriver according to claim 6, wherein the base defines a rim and thedrive surface is provided to said rim.
 8. A sheet driver according toclaim 1, wherein the first and second spring legs protrude from firstand second ends of the spring.
 9. A sheet driver according to claim 1wherein the hub fits over the torsion spring and shaft.
 10. A sheetdriver according to claim 1, wherein the hub is provided with sheetengaging means for engaging the end of a sheet.
 11. A sheet driveraccording to claim 10, wherein the sheet engaging means comprisesloop-engaging means for engaged receipt of a looped end of a sheet. 12.A medicament dispenser for use with a medicament carrier having aplurality of pockets for containing medicament wherein said pockets arespaced along the length of and defined between first and second sheetssecured to each other and separable by drivable pulling action, saiddispenser having an internal dispensing mechanism for accessing saidmedicament contained within said medicament carrier, said mechanismcomprising, a) an opening station for receiving a pocket of saidmedicament carrier; b) peeling means positioned to engage a base sheetand a lid sheet of a pocket which has been received in said openingstation for peeling apart such a base sheet and lid sheet, to open sucha pocket, said peeling means including a sheet driver according to claim1 for pulling apart a lid sheet and a base sheet of a pocket that hasbeen received at said opening station; c) an outlet, positioned to be incommunication with an opened pocket through which a user can removemedicament from such an opened pocket; and d) indexer for indexing incommunication with said outlet, pockets of a medicament carrier in usewith said medicament dispenser, said indexer being interconnected withsaid sheet driver such that movement of one correlates with the movementof the other.
 13. A medicament dispenser for use with plural medicamentcarriers, each having a plurality of pockets for containing medicamentwherein said pockets are spaced along the length of and defined betweenfirst and second sheets secured to each other and separable by drivablepulling action, said dispenser having an internal dispensing mechanismfor accessing said medicament contained within each of said pluralmedicament carriers, said mechanism comprising, a) an opening stationfor receiving a pocket of each of said plural medicament carriers; b)peeling means positioned to engage a base sheet and a lid sheet of apocket which has been received in said opening station for peeling apartsuch a base sheet and lid sheet, to open such a pocket, said peelingmeans including a sheet driver as according to claim 1 for pulling aparta lid sheet and a base sheet of a pocket that has been received at saidopening station; c) an outlet, positioned to be in communication with anopened pocket through which a user can remove medicament from such anopened pocket; and d) an indexer for indexing in communication with saidoutlet, pockets of each of said plural medicament carriers in use withsaid medicament dispenser, said indexer being interconnected with saidsheet driver such that movement of one correlates with the movement ofthe other.
 14. A medicament dispenser according to claim 12, wherein theindexer comprises a rotatable index wheel having pocket receivingrecesses therein.
 15. A medicament dispenser according to claim 12,additionally comprising an indexing lever for actuating the indexer andsheet driver.
 16. A medicament dispenser according to claim 12, whereinthe indexing lever couples to a movable cover provided to the dispensersuch that movement of the cover results in movement of the indexinglever.
 17. A medicament dispenser according to claim 12, wherein thepeeling means additionally comprises a guide for guiding the lid sheetand base sheet along separate paths at the opening station.
 18. Amedicament dispenser according to claim 12, additionally comprising atleast one medicament carrier having a plurality of pockets containingmedicament wherein said pockets are spaced along the length of anddefined between first and second sheets secured to each other andseparable by drivable pulling action.
 19. A medicament dispenseraccording to claim 18, wherein said at least one medicament carriercomprises a lid sheet which is hermetically sealed to a base sheetexcept in the region of the blisters such that said lid sheet and basesheet can be peeled apart by said drivable pulling action.
 20. Amedicament dispenser according to claim 18, wherein the leading end ofeither the base or lid sheet or is looped for receipt by the hub.
 21. Amedicament dispenser according to claim 18 adapted to prevent the sheetdriver unwinding.
 22. A medicament dispenser according to claim 18,wherein the medicament is selected from the group consisting ofalbuterol, salmeterol, fluticasone propionate and beclomethasonedipropionate, and salts thereof, or solvates thereof and any combinationthereof.
 23. A medicament dispenser according to claim 22, wherein saidcombination comprises salmeterol xinafoate and fluticasone propionate.24. A medicament dispenser according to claim 23, wherein the medicamentadditionally comprises an excipient.